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Objective: To investigate the pharmacological potential of Argemone mexicana in treating constipation and emesis by using in vitro and in vivo models. Methods: The spasmogenic and spasmolytic effects were evaluated on isolated rabbit jejunum fragments loaded in a tissue organ bath. The response was recorded with an isotonic transducer attached with Power Lab Data Acquisition System. The laxative and antiemetic activities were assessed in BALB-c mice and poultry chicks challenged with carbamylcholine and copper sulphate stimulated emesis, respectively. Results: The total phenolic and total flavonoids contents of the extract were (267.75 ± 5.77) mg GAE/g and (73.86 ± 6.01) mg QE/g, respectively. Argemone mexicana extract exerted spasmogenic effect on isolated rabbit jejunum segments with an EC50 value of 0.016 mg/mL, which was blocked by atropine (0.3 μM). Argemone mexicana extract exerted spasmolytic effect in atropine treated jejunum fragments with an EC50 value of 2.185 mg/mL. Furthermore, Argemone mexicana extract relaxed potassium (80 mM)-induced contractions (EC50: 9.07 mg/mL), similar to a standard drug verapamil. The calcium channel blocker activity was confirmed by a rightward shift of concentration-response curve of calcium in the presence of Argemone mexicana extract (1-5 mg/mL) and verapamil (0.1-1 μM). In addition, the extract increased the distance travelled by a charcoal in the gastrointestinal tract and exhibited antiemetic effect on copper sulphate induced emesis in chicks. Conclusions: Argemone mexicana shows cholinergic agonist and calcium channel blocker activities, as well as antiemetic effect. It may be used as a potential agent for treating gastrointestinal disorders.
ABSTRACT
Objective: To investigate the pharmacological potential of Argemone mexicana in treating constipation and emesis by using in vitro and in vivo models. Methods: The spasmogenic and spasmolytic effects were evaluated on isolated rabbit jejunum fragments loaded in a tissue organ bath. The response was recorded with an isotonic transducer attached with Power Lab Data Acquisition System. The laxative and antiemetic activities were assessed in BALB-c mice and poultry chicks challenged with carbamylcholine and copper sulphate stimulated emesis, respectively. Results: The total phenolic and total flavonoids contents of the extract were (267.75 ± 5.77) mg GAE/g and (73.86 ± 6.01) mg QE/g, respectively. Argemone mexicana extract exerted spasmogenic effect on isolated rabbit jejunum segments with an EC50 value of 0.016 mg/mL, which was blocked by atropine (0.3 μM). Argemone mexicana extract exerted spasmolytic effect in atropine treated jejunum fragments with an EC50 value of 2.185 mg/mL. Furthermore, Argemone mexicana extract relaxed potassium (80 mM)-induced contractions (EC50: 9.07 mg/mL), similar to a standard drug verapamil. The calcium channel blocker activity was confirmed by a rightward shift of concentration-response curve of calcium in the presence of Argemone mexicana extract (1-5 mg/mL) and verapamil (0.1-1 μM). In addition, the extract increased the distance travelled by a charcoal in the gastrointestinal tract and exhibited antiemetic effect on copper sulphate induced emesis in chicks. Conclusions: Argemone mexicana shows cholinergic agonist and calcium channel blocker activities, as well as antiemetic effect. It may be used as a potential agent for treating gastrointestinal disorders.
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Background: HRQL is important in improving the quality of patient care. However, there is a paucity of data from low-income and middle-income countries (LMIC). Differences in socio-demographics and socio-cultural contexts may influence HRQOL. Therefore, this research was designed with the aim to explore the HRQOL in patients after Percutaneous Coronary Intervention (PCI).Objective: The goal of the study was to evaluate the quality of life after six months of Percutaneous Coronary Intervention using HeartQol questionnaire at a tertiary care hospital in Pakistan.Method: This was a Cross-sectional, descriptive study. Patients between the ages of 20-60 years who underwent primary Percutaneous Coronary Intervention at least 6 months ago were inducted in the study. Coronary angiography was performed mostly through radial as preferred route. Data was collected using a structured questionnaire covering demographic characteristics, predisposing risk factors, procedural details, and quality of life. Heart related Quality of life was assessed using HeartQol questionnaire. Collected data was analyzed using SPSS v.21.Results: A total of 241 patients participated in the study. Mean age of the patients was 53.37±11.07 years. On analysis of quality of life at six months, the median (IQR) HeartQol score was 31 (37-23) with majority of the patients, 84.22% (203) fall under the excellent score (>20).Conclusion: It is of enormous prognostic importance that the quality of life of patient is assessed on a regular basis after PCI. Our study shows that the majority of patients had improved quality of life at six months of PCI. Majority of patients were not bothered by mild symptoms. Further investigation needs to be done to validate these results.
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Objective: To determine whether intraoperative local injection of 0.5% bupivacaine around port sites would decrease early postoperative pain after laparoscopic cholecystectomy, and the use of intravenous opioid analgesics postoperatively
Study Design: Randomised controlled trial.
Place and Duration of Study: Department of Surgery, Khyber Teaching Hospital, Peshawar, from July 2016 to June 2017
Methodology: Patients who underwent laparoscopic cholecystectomy were divided into two groups. Group A had instillation of 20 ml of 0.5% Inj. bupivacaine at the end of procedure into port sites and group B had no bupivacaine injection at trocar sites. Both groups had postoperative intravenous ketorolac 30 mg three times daily and intravenous opioid analgesics on demand. Pain was assessed 2 hours after recovery from general anesthesia, and at 6, 12 and 24 hours through visual analog scale 0-10
Results: One hundred and twenty patients completed this study with 60 patients in each group. A significant difference in mean postoperative pain scores was observed at 2 and 6 hours after surgery between the groups. Pain scores at 2 and 6 hours after surgery were 3.97 +/- 1.327 and 3.02 +/- 1.08 in group A, while it was 4.65 +/- 1.448 and 4.72 +/-1.277 in group B with p-values of 0.008 and 0.005, respectively. There was no significant difference in mean postoperative pain scores at 12 and 24 hours between the groups, with pain scores of 3.72 +/- 0.78 and 3.75 +/- 0.95 [p=0.488 and 0.744, respectively]. However, there was a significant difference in opioid analgesics use in first 24 hours with less analgesics use in bupivacaine injected group
Conclusion: Injecting 0.5% bupivacaine at trocar sites during laparoscopic cholecystectomy offers significant reduction in early postoperative pain
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The present study was aimed at preparation of transdermal patches of tizanidine HCl, evaluation of the effect of polymers on in vitro release pattern of the drug, and the effect of permeation enhancers on the penetration of the drug through the rabbit skin. Various proportions of hydrophilic (HPMC) and hydrophobic (Eudragit L-100) polymers were used with PEG 400 as film-forming agent, and Span 20 or DMSO as permeation enhancer. The formulations were assessed for physicochemical characteristics and in vitro drug release studies using USP paddle over disc method in phosphate buffered saline (pH 7.4) at 32.0±1°C. On the basis of in vitro studies and physicochemical evaluations, S03-A and S04-A were selected at Eudragit : HPMC ratios of 8 : 2 and 7 : 3, respectively, for further ex vivo analysis. The effects of different concentrations of Span 20 and DMSO were evaluated on excised rabbit skin using Franz diffusion cell. Cumulative drug permeation, flux, permeability coefficient, target flux, and enhancement ratio were calculated and compared with the control formulations. Kinetic models and Tukey's multiple comparison test were applied to evaluate the drug release patterns. Formulation SB03-PE containing Eudragit L-100:HPMC (7:3) with Span 20 (15% w/w) produced the highest enhancement in drug permeation, and followed zero order kinetic model with super case-II drug release mechanism.
Subject(s)
Animals , Rabbits , Transdermal Patch/classification , Transdermal Patch/supply & distribution , In Vitro Techniques , Pharmaceutical Preparations/analysis , Hydrophobic and Hydrophilic Interactions , Drug Liberation/drug effectsABSTRACT
Background: Multidrug resistant tuberculosis caused by Mycobacterium tuberculosis is an infection that is resistant to rifampicin and isoniazid. Management of Multidrug resistant tuberculosis is a serious challenge worldwide
Objectives: To investigate hotspot mutations in rpoB, katG and inhA genes and its possible co-relation with predominant genotypes in Khyber Pakhtunkhwa, Pakistan
Study design, settings and duration: This cross sectional study was conducted after approval from research and ethics committee of Provincial TB Control Program, Khyber Pakhtunkhwa in March 2015
Materials and Methods: A total of 166 clinical isolates were analysed which were collected from programmatic management of drug-resistant tuberculosis units. All samples were characterized by phonotypical drug susceptibility test, genotypic drug resistant test [line probe assay] and spoligotyping analysis using ''TB-SPRINT' micro bead assay
Results: Out of the total 166 samples, 97 strains were resistant to rifampicin [RIF] and 106 strains were resistant to isoniazid [INH]. Most common mutation in rpoB was S531L in 75 [77%] isolates followed by D516V in 10 [10%] and H526Y in 6 [6%] samples respectively. A rare mutation in rpoB gene at codon 522 and deletion of codon 518 was also reported. In 106 INH resistant strains, 97[91%] were associated with mutation in katG gene while resistance in 9 [8.4%] strain was due to mutation in the inhA promoter region. Spoligotyping analysis revealed 55 distinct types of different patterns. Spoligotyping patterns of 146 samples matched with 15 different linage of M.tuberculosis in which 101 [60%] were identified as the predominant CAS1-Delhi linage. The pattern of 20 strains [12%] did not matched to any other pattern in the SITVIT database and were named orphan KP
Conclusion: Molecular characterization of M.tuberculosis is very helpful in the early identification of MDR-TB. As CAS1-Delhi is the predominant type in this region, its association with drug resistance, treatment failure and patient demographic profiles should be investigated
Subject(s)
Humans , Tuberculosis/epidemiology , Molecular Typing , Tuberculosis, Multidrug-Resistant/diagnosis , Endemic Diseases , Cross-Sectional StudiesABSTRACT
To estimate the most prevalent age of patients and disease status and progression in terms of severity at different age groups in the Pakistani Rheumatoid Arthritis [RA] patients. A total of five hundred [500] RA patients were enrolled during October, 2009 to October, 2013. A screening questionnaire was filled for each patient satisfying America College of Rheumatology [ACR] criteria under the supervision of certified rheumatologists. Epidemiological and demographic variables were statistically analyzed for correlation with progression of the disease using SPSS ver 17.0.1 software. In general, rheumatoid arthritis preferentially affects women with female to male ratio of about 3:1; however, patients with above 60 years of age have equal female to male ratio. The most prevalent age is 45-60 years. The disease severity increases with increase in the age and reaches to its peak in above 60 years of age [p=0.001]. The pattern of progression of RA in the Pakistani patients is almost consistent with other relevant studies conducted on European and European derived populations
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Surveys and Questionnaires , Immune System Diseases , Disease ProgressionABSTRACT
The aim of the present study was to investigate the potential of nanoemulsion formulation for topical delivery of Clobetasol propionate [CP] using algal oil [containing omega-3 fatty acids] as the oil phase. CP has anti-inflammatory, immunomodulatory and antiproliferative activities. However, its clinical use is restricted to some extent due to its poor permeability across the skin. Algal oil was used as the oil phase and was also exploited for its anti-inflammatory effect along with CP in the treatment of inflammation associated with dermatitis. Nanoemulsion formulations were prepared by aqueous phase titration method, using algal oil, tween 20, PEG 200 and water as the oil phase, surfactant, co-surfactant and aqueous phase respectively. Furthermore, different formulations were subjected to evaluate for ex-vivo permeation and in-vivo anti-inflammatory, irritation and contact dermatitis studies. The optimized nanoemulsion was converted into hydrogel-thickened nanoemulsion system [HTN] using carbopol 971 and had a viscosity of 97.57 +/- 0.04 PaS. The optimized formulation had small average diameter [120 nm] with zeta potential of -37.01 mV which indicated good long-term stability. In-vivo anti-inflammatory activity indicated 84.55% and 41.04% inhibition of inflammation for drug loaded and placebo formulations respectively. The assessment of skin permeation was done by DSC and histopathology studies which indicated changes in the structure of epidermal membrane of skin. Contact dermatitis reveals that the higher NTPDase activity in the treatment with the CP-loaded nanoemulsion could be related to the higher anti-inflammatory effect in comparison with placebo nanoemulsion gel
Subject(s)
Fatty Acids, Omega-3 , Dermatitis, Contact , Anti-Inflammatory Agents , Docosahexaenoic AcidsABSTRACT
To study the adaptive strategies from harmful effect of heat wave on an urban, educated, well to do subjects for a period of May to July 2014. 250 selected young students of RIHS. Descriptive Study. Rawal Institute of Health Sciences, Islamabad. March - July 2014. A questionnaire was circulated among the students of Rawal Institute of Health Sciences Islamabad regarding effects of heat and measures taken to combat its effects. A total of 250 urban students with mean age of 19.77 +/- 1.10 years were inducted in the study, having resources to face the extreme heat. A significant number of female non boarder students [p=0.000], wearing cotton clothes [p=0.000] having fair skin [p=0.000] and using air condition at homes [p=0.000] were not acclimatized to heat waves still have headache and anxiety. A great percent of students did not complaint of headache, heat exhaustion, heat cramp or syncope, except mild sweating, effect on studies. A great percentage [>65%] of students complained of malaise, nausea vomiting. Male students showed increase thirst than female, while anxiety state was noticed more in female than male students. The use of cotton clothing, daily bathing, increased water intake and use of air conditioner minimized the severe adverse effects like heat exhaustion, heat syncope, and heat stroke, although the minor effects like skin tanning, disturbed sleep, anxiety and adverse effects on studies cannot be avoided in heat wave season
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Objective To study the frequency of cutaneous manifestations of obesity and their association with severity of disease in Pakistani population.
Methods 100 outdoor patients visiting Rawal Institute of Health Sciences, Islamabad were studied during a period from May 2014 to July 2015. BMI was calculated by measuring weight in kilogram divided by square in height in meter. Cutaneous manifestations in obese patients with class I [CI] [BMI >30-34.9Kg/m2] and class II [CII] [BMI 35-39Kg/m2] disease were recorded.
Results The mean age was 41.85+/-8.61 years while the mean BMI was 33.51+/-2.51 kg/m2. A significant difference for diabetes mellitus, striae and acanthosis nigricans was seen between CI and CII groups [p<0.05]. BMI showed significant positive correlation with DM [r=0.280, p=0.005] and acne [r=0.315, p=0.001] while diabetes mellitus showed with acanthosis nigricans [r=0.373; p=0.000] and skin tags [r=0.218, p=0.029]. Acne showed with miliaria [r=0.210, p=0.036] and varicose vein with xanthomas [r= 0.281, p=0.005].
Conclusion Skin tags, acanthosis nigricans and acne are seen more frequently in obesity.
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Diphtheria is caused by Corynebacterium diphtheriae primarily affecting mucous membrane of upper airways. Global incidence of diphtheria has reduced due to worldwide immunization programs. Yet cases of diphtheria are reported across the world because of poor vaccine coverage, large population and low socio economic status. We report here a case of diphtheria in an 11-year-old girl who presented with fever, sore throat, difficulty in swallowing and hoarseness of voice for 3 days. Hematological analysis showed neutrophit leukocytosis with normal lymphocytes, CRP was raised, cardiac profile, renal function test, hepatic functions and chest x-ray were normal. Microscopy of throat swab revealed rods containing metachromatic granules .on Albert stain. Intramuscular penicillin was started and diphtheria antioxin was administered. The child recovered uneventfully and was kept on follow up
Subject(s)
Humans , Female , Pharyngitis/diagnosis , Fever , Hoarseness , Corynebacterium diphtheriaeABSTRACT
To determine the recurrence rate following Conjunctival Autograft versus Mitomycin C for pterygium excision. Fifty Patients in this Randomized Clinical Trial who underwent pterygium excision from July 2013 to October 2013 at Department of Ophthalmology, Ziauddin University Hospital, Keamari, Karachi were included. All patients underwent detailed ophthalmic examination before surgery. Few drops of lidocaine were instilled, subconjunctival xylocaine 2% was injected. The pterygium was then excised from bulabar conjunctiva and peeled off from the corneal surface. Mitomycin C was applied to bare sclera in group A and Conjunctival autograft taken from superior bulbar conjunctiva of same eye was sutured to the bare sclera in group B. Data for pterygium recurrence was collected and analyzed using SPSS version 17. Among the 50 patients operated 64% [n=32] were male and 36% [n=18] female. Their age ranged from 28 - 58 years with mean age 44.8 years. Right eye was affected in 54% [n= 27] patients and left in 46% [n= 23]. In group "A" [intraoperative MMC] conjunctival granuloma was noted in 1[4%], pterygium recurrence 4[16%] and ocular irritation was experienced by 5[20%] patients. In group "B" [CAG] graft retraction was seen in 2[8%], patients, 1[4%] patients experienced persistent redness over the grafted tissue and pterygium recurrence was seen in 2[8%] patient. All of them were followed at day 1, week 1, week 4 and week 12. Both Conjunctival Autograft and Mitomycin C are effective in reducing the recurrence of pterygium but CAG gives better cosmetic results, the only drawback with it is the duration of the procedure
Subject(s)
Humans , Male , Female , Mitomycin , Intraoperative Care , Recurrence , Conjunctiva , AutograftsABSTRACT
Background: Treatment outcome is key indicator to assess the effectiveness of TB control program
Objective: To determine the treatment outcome in tuberculosis patients registered at Department of Pulmonology, Sheikh Zayed Medical College / Hospital, Rahim Yar Khan
Patients and Methods: All the patients registered at DOTS clinic, Department of Pulmonology, Sheikh Zayed Medical College / Hospital, Rahim Yar Khan from 1[st] January, 2008 to 31[st] December 2009, were followed up till completion of their prescribed regimen to determine the WHO endorsed treatment outcome. Patients were classified according to site of disease [pulmonary vs extra pulmonary], history of previous treatment and sputum smear status
Results: Of the 1607 registered TB patients, majority of the patients [83.9%] were newly diagnosed, young [median age: 30 years] and have pulmonary TB [74.9%]. Overall treatment success rate was 77%. New cases fared better [80.6%] than previously treated patients [53.7%]. Among previously treated group, treatment outcome was as follows; relapse [62.7%], treatment after default [52.7%] and treatment failure [33.3%]. Extra pulmonary tuberculosis cases fare better than pulmonary case with success rate of 87.7% and 72.5%, death rate 11% and 3.2%, failure rate 1.9% and 0.2% and default rate of 6.9% and 10.6% respectively
Conclusion: Considering the WHO standard of 85% treatment success rates, only the newly diagnosed patients were close to achieve the target. Previous exposure to anti tuberculosis treatment especially inadequate one was closely associated with poor outcome. Efforts should be made to ensure proper management of all TB cases
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Benign prostatic hyperplasia [BPH]is the most common condition in aging men, associated with lower urinary tract symptoms. It is caused due to the augmented levels of the androgen dihydrotestosterone. Dutasteride, a 5alpha-Reductase inhibitor has been recommended for the treatment of BPH upon oral administration. However, long term oral administration of dutasteride may cause sexual problem in man. Therefore the main objective of this study was to develop transdermal patch having nanoemulsion gel of dutasteride in order to enhance physical and chemical stability and eliminate adverse effect of dutasteride. Optimized nanoemulsion was prepared by aqueous phase-titration method and characterized by droplet size, viscosity and refractive index. In-vitro skin permeation of dutasteride through rat abdominal skin was determined by the Franz diffusion cell. Significant increase in the steady state flux [Jss], permeability coefficient [Kp] and enhancement ratio [Er] was observed in optimized nanoemulsion formulation A1 [p < 0.05]. The Er of optimized nanoemulsion A1 was found to be 1.52 times with respect to control which indicates transdermal delivery may be better approach for BPH. Stability studies were performed for the period of 3 months. It was found that droplet size, viscosity and refractive index were slightly increased at refrigerator and room temperature in 3 months period. However, the changes in these parameters were not statistically significant [p >/= 0.05]. The shelf-life of optimized nanoemulsion A1 was found to be 2.18 years at room temperature. These results indicated that both physical as well as chemical stability of dutasteride in nanoemulsion formulation
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Background: Worldwide, tuberculosis and viral hepatitis are common diseases and both remain underdiagnosed and under-treated. Co-infection with tuberculosis and hepatitis is likely to make diagnosis, management and control of either disease difficult and challenging
Objective: To determine prevalence of HCV and HBV infection among PTB patients at Rahim Yar Khan, Pakistan
Patients and Methods: One hundred sputum smear positive pulmonary tuberculosis patients were screened for HCV and HBsAg. In this cross-sectional study, from 1st April to 31st December, 2010 results were analyzed by age, gender, marital, educational and socioeconomic status by using SPSS version 15
Results: Sociodemographic data showed that 66% patients were young between 15-49 years. Only 8 patients had history of blood transfusion, 4 had traveled abroad and none was drug abuser. Most of them were poor. Out of 100 patients [56 male and 44 female] 22% patients were positive for HCV and 3% for HBsAg. Prevalence of HCV infection was significantly higher in married [p value 0.03] and in those with history of blood transfusion [p value 0.004]. No significant statistical difference of prevalence of HCV between male and female, urban and rural, educated and uneducated and in those who traveled abroad or not was found
Conclusion: Prevalence of HCV infection among the pulmonary tuberculosis patients at Rahim Yar Khan [22%] is alarmingly high as compared with general adult Pakistani population [approx. 4.7%]
ABSTRACT
Background: Universal HIV testing for all TB patients regardless of their individual risk factors is being recommended by most of the authorities including WHO in recent guidelines
Objective: To determine the prevalence of HIV infection among Pulmonary TB patients presenting at Department of Pulmonology, Rahim Yar Khan, Pakistan
Patients and Methods: In this cross sectional study, one hundred consecutive newly registered smear positive pulmonary TB patients presented at Department of Pulmonology, Sheikh Zayed Medical College, Rahim Yar Khan from 1[st] April to 31[st] December 2010 were included in this study. Interviews were conducted to record the sociodemographic data and various HIV related risk factors for all patients. Consent was taken from the patients to be included in this study and for HIV testing. Test was done by ICT method at department of pathology of this institute. The data was entered and analyzed in SPSS version 15
Results: Out of 100 TB patients in this study, 56 were male and 44 were female. Majority [51%] of the patients were uneducated. Only 24% were earning more than ten thousands rupees per month. Sixty six percent patients were aged between 15-49 years. All the patients gave their consent for HIV testing. Only 4 of the 100 subjects had travelled abroad, 8 had history of blood transfusion and none of the patients admitted any history of drug abuse. None of the 100 patients in this study was positive for HIV infection
Conclusion: Despite the presence of risk factors in considerable number of participants of this study, HIV infection was not detected in any of the Pulmonary TB patient. This finding put a question mark over universal recommendation of HIV testing in all TB patients worldwide. However, larger study including all TB patients, both Pulmonary as well as Extra Pulmonary is required to confirm this finding
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To study the protective role of beta carotene against acetaminophen-induced hepatotoxicity in rats. Laboratory based randomized control trial. Department of Anatomy Army Medical College, Rawalpindi; in collaboration with National Institute of Health [NIH], Islamabad. The study duration was one year from Feb, 2009 to Jan, 2010. Sixty young adult [4-6 weeks old] Sprague-Dawley rats weighing 180-240 g were randomized into three groups. Control group C was given NIH laboratory diet, experimental group A was given toxic dose of acetaminophen 700 mg/kg body weight once daily and experimental group B was given beta carotene 30 mg/kg body weight once daily along with 700 mg/kg body weight acetaminophen once daily for one week. Liver specimens were collected 24 hours after the last dose. Five micron thick sections of liver were stained with H and E for histomorphological study. Microscopic examination demonstrated various grades of periportal and spotty necrosis in experimental group A as compared to control group C. In experimental group B, there was significant attenuation [P-value < 0.001] in periportal and spotty necrosis. It was concluded that beta carotene has hepatoprotective role on histomorphology of liver in acetaminophen-induced hepatotoxicity in rats
Subject(s)
Animals, Laboratory , Liver/anatomy & histology , Acetaminophen , Rats, Sprague-Dawley , Liver/drug effects , NecrosisABSTRACT
To determine the factors related to tobacco smoking among students of grade 6-10 in an urban setting in Sindh, Pakistan. Cross-sectional survey. The study was conducted in public and private schools of Hyderabad, Sindh, Pakistan, from January 2008 to June 2009. A sample of 501 students from grade 6-10 were selected through simple random sampling and probability proportional to size. Students answered to a pre-tested questionnaire on sociodemography and tobacco use. Descriptive statistics were used to determine frequency distribution. About 9% of the students were smoking some form of tobacco. Ten percent had tried cigarette smoking and about 80% and 61% were chewing Areca nuts and 'Paan' [concoction of Areca nuts, tobacco, hydrated lime, herbs and spices wrapped in betel leaf. Being old, male gender, peer influence, personal attitude toward future smoking, chewing 'Gutka' [concoction of tobacco, Areca nuts and hydrated lime] and having a more educated mother was associated with greater frequency of smoking any form of tobacco. High frequency of tobacco smoking, the attitude toward tobacco consumption and a very high consumption of Areca nuts and other chewable tobacco products by the children warrants urgent action in order to control the tobacco epidemic in Pakistan
ABSTRACT
Retinal vein occlusions [RVO] are the second commonest sight threatening vascular disorder. Branch retinal vein occlusion [BRVO] and central retinal vein occlusion [CRVO] are the two basic types of vein occlusion. Branch retinal vein occlusion is three times more common than central retinal vein occlusion and- second only to diabetic retinopathy as the most common retinal vascular cause of visual loss. The origin of branch retinal vein occlusion undoubtedly includes both systemic factors such as hypertension and local anatomic factors such as arteriovenous crossings. Branch retinal vein occlusion causes a painless decrease in vision, resulting in misty or distorted vision. Current treatment options don't address the underlying aetiology of branch retinal vein occlusion. Instead they focus on treating sequelae of the occluded venous branch, such as macular oedema, vitreous haemorrhage and traction retinal detachment from neovascularization. Evidences suggest that the pathogenesis of various types of retinal vein occlusion, like many other ocular vascular occlusive disorders, is a multifactorial process and there is no single magic bullet that causes retinal vein occlusion. A comprehensive management of patients with retinal vascular occlusions is necessary to correct associated diseases or predisposing abnormalities that could lead to local recurrences or systemic event. Along with a review of the literature, a practical approach for the management of retinal vascular occlusions is required, which requires collaboration between the ophthalmologist and other physicians: general practitioner, cardiologist, internist etc. as appropriate according to each case